Health

Rael & Letson consultants work on strategic and everyday issues for our clients, which include Taft-Hartley funds, multi-employer funds, governmental and public sector plans, VEBAs, and corporate plans. Some of the key areas we focus on for clients include:
      • Network Discounts and Renewals
      • Pharmacy Benefits
      • Marketplace Solutions and Innovations
      • Compliance
      • Stop Loss Coverage
      • Projections, Plan Mergers, and Withdrawals
Network Discounts and Renewals.  Your carrier network is a very important part of the benefits purchased for your covered populations.  Hospital and medical claims can make up to 70% or more of a fund’s expenses, while dental network claims can easily constitute an additional 10 to 15% of benefit expense. Rael & Letson helps clients secure medical, dental, and vision networks with broad access and cost-competitive discounts:
      • We have a deep understanding of carriers and business models in the marketplace, including fully insured plans, self-insured plans, and hybrid plans
      • We leverage this knowledge to secure aggressive renewals and/or issue competitive requests for proposals (RFPs) to the marketplace. We are successful at negotiating multi-year fees, often with rate caps or not-to-exceed guarantees
      • Benchmarking and relevant comparisons
      • We help clients assess member impact (e.g., will members gain or lose access to provider or prescription drug?) and support implementation to make sure there are no surprises for trustees or members
Pharmacy Benefits.  Next to medical claims expenses, pharmacy drug spend can be a significant portion of plan expenses, with pharmacy expenses ranging from 20% to 50% of total benefit expense. Rael & Letson has significant expertise in evaluating pharmacy benefits plans in various ways, including:
      • Is a traditional or transparent pharmacy benefit management model (PBM) the best fit for my plan?
      • Should my plan carve-in or carve-out prescription drug coverage?
      • Are there alternative funding arrangements for very high-cost drugs and/or gene therapies?
      • Do group purchasing coalitions make sense for my plan?
Rael & Letson can provide a range of consulting services in these areas, from market checks to full RFPs. In addition, we offer guidance and analysis that help plan sponsors understand the impact on members in terms of access (which pharmacies are included/excluded) and formulary coverage (which drugs are generic, brand, specialty, etc.). Marketplace Solution and Innovations.  In health care, despite marketing and sales hype, there are very few silver bullets to solve the cost, access, and quality problems faced by plan sponsors.  Rael & Letson has informed knowledge and deep understanding of the new programs and solutions coming on the market. We assist clients to understand solutions and innovations by:
      • Searching for solutions that address specific problems and pain points
      • Evaluating care management such as telemedicine and musculoskeletal (MSK) health
      • Analyzing potential costs and impacts
      • Negotiating favorable cost, terms, and conditions
Compliance. The Consolidated Appropriations Act (CAA) and No Surprises/Transparency Act (NSA and TiC) requirements have made compliance a top priority for plan sponsors.  While much of the implementation for these requirements is completed, underway, or scheduled to occur in the near future, guidance is continually getting fine-tuned, delayed, or amended. As a result, regulatory compliance remains a top agenda item for the foreseeable future. Rael & Letson assists clients by:
      • Coordinating fund professionals and vendor service providers to meet compliance deadlines
      • Working with fund professionals to ensure common understanding of rules and regulations
      • Identifying service provider capabilities to meet requirements
      • Apprising plan sponsors of options and alternatives
      • Keeping clients and fund professionals updated by monitoring legislative and compliance issues
Stop Loss Coverage.  Plan sponsors must constantly manage risks and costs associated with high-cost claims in areas such as cancer, preterm births, and transplants. In addition, new and expensive gene therapies represent significant potential risks to plans. Rael & Letson can help you understand risks and help you navigate options to secure the most effective stop loss coverage for your group. We pay particular attention to:
      • Whether stop loss coverage includes/excludes very expensive new gene therapies
      • Reducing cost-shifting to the fund through the use of lasers
      • Ensuring that stop loss coverage ‘mirrors’ current plan design, as much as possible
      • Access to Centers of Excellence when available
Projections, Plan Mergers, and Withdrawal Analyses. Plan sponsors need consistent and reliable projections and financial reporting to balance operating expenses and reserves over time.  This is where the rubber meets the road for most funds. Rael & Letson provides multi-year projections and financial experience reports that form the cornerstone of a fund’s financial management. These reports are comprehensive and based on:
      • Financial reporting
      • Eligibility
      • Contributions
      • Claims Experience and Expected Trend
Plan mergers and withdrawals are a reality in the multi-employer trust world. Some key areas our merger/withdrawal analyses focus on include:
      • Impact of withdrawal on reserves, hours bank, and IBNP
      • Potential risk charges/loads to build reserves for groups merging in
      • Savings opportunities or stronger purchasing power through efficiencies/reducing redundancies
Rael & Letson strives to think wholistically and comprehensively, using data and experience, to provide decision-makers with the fullest range of options and alternatives possible. We don’t just focus on the economics but also always consider the impact on members and their families.  

Time to review your Pharmacy Benefit Manager (PBM) contract?

We can benchmark your current agreement, help you negotiate a favorable deal, introduce lower cost opportunities for expensive medications, and audit your PBM to make sure they are complying with all contract terms.

Time to review your Pharmacy Benefit Manager (PBM) contract?

The Rael & Letson healthcare practice has specialized expertise in the pharmacy benefit management (PBM) space and can deliver solutions for your self-funded prescription drug benefit program.  Such services include:

  • Claims review of detailed data and monthly tracking of performance;
  • Review of PBM reporting and discussion of tailored clinical programs;
  • PBM RFP solicitation and review of results,  including contract review of the new selected PBM and assistance in the implementation process;
  • Financial audits performed at the end of each contract year to ensure PBMs have met their financial guarantees; and
  • Overall support in the event questions or issues arise related to the prescription benefit plan or dealings with the PBM.

Let us know how we can help.

Retiree benefit costs and options a concern?

Talk to us about ideas to control retiree medical costs while enhancing choice for your retirees, including an RDS audit to recover Medicare subsidy dollars, or an Employer Group Waiver Plan (EGWP) that can offer additional savings.

Retiree benefit costs and options a concern?

Retiree costs continue to be an ongoing concern for most trust funds as subsidy levels have grown over time. We can assist in evaluating the retiree population of your health plan to determine whether a private exchange is a viable option for your Medicare retirees. We also have relationships with Medicare Part D vendors that can conduct a RDS audit to identify Part D overpayments and recoveries. If a RDS approach is not producing the results desired, we can identify whether an EGWP approach is a more suitable solution and advise you of the pros and cons of using such an approach.  

Need help in implementing a consumer directed health plan that meets your objectives? 

If you are considering implementing a Health Reimbursement Arrangement (HRA) or Health Savings Account (HSA), we can provide you with options that address your specific concerns, such as developing the appropriate plan design, searching for the right vendor, and preparing the plan document.

Need help in implementing a consumer directed health plan that meets your objectives? 

Consumer directed health plans have become dynamic vehicles that allow participants to have more control over their health care spending needs. By diverting employer contributions to a Health Reimbursement Account (HRA), trust funds can lower the cost of medical and prescription drug plans by re-designing benefits, or by eliminating retiree subsidies and giving active participants the opportunity to save for retiree medical coverage. Recent regulatory changes related to Health Reimbursement Arrangement Accounts (HRA) may significantly increase the use of HRA’s.  We can assist in all phases of a HRA or HSA implementation for your active and retiree participants.

Interested in Primary Care delivery alternatives?

Off/Near site clinics, create interesting opportunities to provide a more robust primary care experience and lower overall health care costs. Ask us about the opportunities and challenges associated with this alternative.

Interested in Primary Care delivery alternatives?

Shortages of local contracted primary care physicians and other related services have presented challenges for some health plans. Other plans desire a more customized approach in delivering primary care to their participants. In either situation, we can assist in exploring opportunities to establish an exclusive clinic for your participants, or partner with an already fully established clinic.

Provider price and quality transparency an issue?

Yes it is. Let’s talk about ways to equip your members and employees with the tools they need to be educated healthcare consumers.

Provider price and quality transparency an issue?

Finding the right physician, specialist, outpatient facility or hospital to perform the quality medical care required has been a struggle for most participants of a health plan. We can assist in finding vendors who specialize in transparency tools that allow participants to select professionals or facilities that achieve the best medical outcomes for a particular procedure with the lowest out-of-pocket exposure.   

Is your Telemedicine benefit working?

Talk to us about your experiences and/or interest in adopting a program.

Is your Telemedicine benefit working?

Video and audio access to a physician who can diagnose your minor illness or injury on a 24/7 basis has become a prominent feature among health plans. The problem lies in generating awareness and participation in a telemedicine program to produce meaningful results. We can assist in finding the right telemedicine vendor for your plan and in developing a promotional campaign to achieve high utilization and ultimately lower costs.  

What are your top health plan issues?

Looking to run it by someone? What are you and your co-workers, fellow Trustees and plan professionals seeing, doing, or concerned about?

What are your top health plan issues?

Specialty Pharmacy costs….Retiree subsidies…… Specialty Networks……Off site clinics…..Primary Care Access…..Telemedicine…. You tell us and we’d love to help you find solutions

Looking to run it by someone? What are you and your co-workers, fellow Trustees and plan professionals seeing, doing, or concerned about? Contact Tom Byrne at tomb@rael-letson.com if you would like some help.

Retiree Health Plans 101

Senior Consultant Wesley Yoder discusses the rules and challenges that plan sponsors face when introducing and managing existing retiree health and welfare plans.Click here for the article featured in Benefits Magazine.

We understand your plans.®